FRAMING HEALTH MATTERS

Psychological First Aid: A Consensus-Derived, Empirically

Supported, Competency-Based Training Model
O. Lee McCabe, PhD, George S. Everly Jr, PhD, Lisa M. Brown, PhD, Aaron M. Wendelboe, PhD, Nor Hashidah Abd Hamid, PhD, Vicki L. Tallchief, EdD,
and Jonathan M. Links, PhD

learners, including midtier public health pro-

Surges in demand for professional mental health services occasioned by
fessionals and lay community members. The
disasters represent a major public health challenge. To build response
capacity, numerous psychological first aid (PFA) training models for pro- product is a component competency set of the
fessional and lay audiences have been developed that, although often Public Health Preparedness and Response
concurring on broad intervention aims, have not systematically addressed Core Competency Model,31 a proposed na-
pedagogical elements necessary for optimal learning or teaching. We describe tional standard of behaviorally based, observ-
a competency-based model of PFA training developed under the auspices of able skills for the workforce to prepare for and
the Centers for Disease Control and Prevention and the Association of Schools respond to all-hazards scenarios. The project
of Public Health. We explain the approach used for developing and refining the was conducted as part of a larger effort by
competency set and summarize the observable knowledge, skills, and atti- 14 Preparedness and Emergency Response
tudes underlying the 6 core competency domains. We discuss the strategies
Learning Centers (PERLCs) in accredited
for model dissemination, validation, and adoption in professional and lay
schools of public health. These centers, funded
communities. (Am J Public Health. 2014;104:621628. doi:10.2105/AJPH.2013.
by the Centers for Disease Control and Pre-
301219)
vention (CDC), aim to develop knowledge,
skills, and attitudes (KSA) content for each of
The beginning of the 21st century has seen operations manuals for both general audiences the competency statements in the model.32 The
considerable attention devoted to improving and specic elds. Specialized PFA curricula project could serve as a basis for enhancing
emergency response capabilities at the na- have been developed for people working with consistency in preparedness training curricula
tional, state, and local levels of the US public the homeless,22 those working in nursing and fullling mandates in the Pandemic and
health emergency preparedness system. A homes,23 Medical Reserve Corps volunteers,24 All-Hazards Preparedness Act 2006.33
daunting challenge has been planning for the faith and lay community leaders,15,16,25,26
disproportionally high volume of psychological and public health workers.27 METHODS
(vs physical) casualties that attend natural, Despite the virtual cottage industry of PFA
technological, and intentional hazards.1---7 Evi- training activities and previous efforts to iden- Faculty representatives (the authors) from 4
dence suggests that many disaster survivors fail tify core competencies16,26---28 and trauma in- PERLC-awarded schools of public health were
to receive the care they need8 and that care tervention principles,29 current PFA training selected to develop subcompetency statements
deprivation under such circumstances is asso- programs have signicant shortcomings, in- and KSAs to foster learning of prociencies
ciated with mental health morbidity and in- cluding variability of content, format, and in providing PFA and in preventing levels of
creased rates of suicide.9,10 The difculty of emphasis (with little motivation for standardi- secondary stress, which are subsumed under
managing disaster-occasioned surges of de- zation); learning objectives and outcomes de- Model Leadership Competency 1.2. (The 3
mand for mental and behavioral health ser- ned in nonobservable constructs that pre- other competency domains, each with 3 to 6
vices is further compounded by the shortage clude meaningful measurement; little external subcompetencies, are Communicate and
of able and willing responders.11---14 accountability for quality; and no in-depth Manage Information, Plan for and Improve
An increasingly popular idea for enhancing analysis of the pedagogical principles for opti- Practice, and Protect Worker Health and
surge capacity during disaster scenarios is to mal learning and teaching of PFA competen- Safety.) The participating institutions were as
develop cadres of potential responders trained cies. The result is a dearth of qualied PFA- follows (listed alphabetically):
in mental and behavioral health management, trained responders available for call-up during
including psychological rst aid (PFA).15---19 The public health emergencies11,13,30 and no widely d
Bloomberg School of Public Health, Johns
American Red Cross20 and the World Health accepted model for training public health Hopkins University;
Organization21 provide PFA training programs, workers in PFA competencies. d
College of Behavioral and Community Sci-
and the National Child Traumatic Stress Net- We describe the development of a PFA ences, University of South Florida;
work and National Center for PTSD (posttrau- training curriculum based on sound pedagogi- d
College of Public Health, University of Iowa;
matic stress disorder) distribute PFA eld cal principles applicable to a broad range of and

April 2014, Vol 104, No. 4 | American Journal of Public Health McCabe et al. | Peer Reviewed | Framing Health Matters | 621

d
College of Public Health, University of Okla-
homa Health Sciences Center.
Workgroup Operations
We crafted measureable statements for
core and subordinate competencies of a PFA
training model by blending the following 3
strategies.
Review of primary-source research evidence.
We systematically reviewed data from pub-
lished16,26,34 and ongoing PFA training re-
search studies conducted at 2 of the partici-
pating institutions. Supported through
numerous grants, including a CDC-funded
Preparedness and Emergency Response Re-
search Center (PERRC) award, these investi-
gations have focused on the development and
validation of KSA-based PFA competencies.
The studies have incorporated a mixed-
methods approach to evaluation, yielding data
from pre---post scores on knowledge tests and
pre---post self-reports of competencies acquired
in trainee cohorts, and from interviews with
community and health department collabora-
tors in Eastern and Midwestern regions of the
United States. From these eld studies, we
developed a draft of KSA constructs underlying
6 core competency and subcompetency do-
mains of PFAa translational PERRC research
to a PERLC training initiative of the kind
intentionally designed into these CDC-funded
programs.
Search of peer-reviewed literature. We con-
ducted literature searches in the Medline,
PsycINFO, Google Scholar, and Thomson
Reuters (formerly ISI) Web of Knowledge
databases. Additionally, we performed litera-
ture searches using the Google and Bing search
engines to locate PFA eld guides, training
programs, presentations, and other relevant
gray literature. We evaluated the information
yield to determine whether the content con-
tained basic PFA tenets and tactics, cited
purportedly crucial learning domains, or ref-
erenced additional published articles in peer-
reviewed journals. This phase of the operations
established that available PFA approaches,
though often proposing relevant strategic goals,
frequently fail to articulate the tactical compe-
tencies to achieve them.
Dissemination of drafts of the competency set
and model training content. Drafts of the PFA
competencies, subcompetencies, training
622 | Framing Health Matters | Peer Reviewed | McCabe et al.
FRAMING HEALTH MATTERS
modules, and empirically derived component
KSAs underwent renement through iterative
cycles of dissemination, feedback, redesign,
implementation, and redissemination. Re-
viewers of early versions of the PFA compe-
tencies were members of PERRC and PERLC
advisory groups, which were composed of
representatives from the elds of education,
environmental health, health care administra-
tion, local and state government, medicine,
psychology, social work, and sociology. We
uploaded later versions of the competency set
to an Internet share site for review and input by
members of the 14 other competency devel-
opment committees of the CDC and the Asso-
ciation of Schools of Public Health (ASPH).
Members of the CDC---ASPH KSA Consultative
Committee vetted the current competency set.
Pedagogical Domains
The pedagogical framework used to assimi-
late the results of the overlapping strategies
encompasses 3 main learning domains.
Cognitive domain: mental skills (knowledge).
We used Blooms Taxonomy,35 which includes
hierarchical cognitive categories from simplest
to complex (e.g., knowledge, application, eval-
uation). We also incorporated advances from
the more recent revision by Anderson and
Krathwohl36 delineating the interaction of
knowledge dimensions (e.g., factual, concep-
tual, procedural) with cognitive processes (e.g.,
remembering, analyzing, creating). The taxon-
omies developed by Bloom and successors,
which classify levels of thinking with different
standards for each level, are used extensively
and effectively in education and training
activities.37
Psychomotor domain: manual or physical
activities (skills). This domain addresses opera-
tional aspects of competency and includes
manipulative and motor skills,38---40 as well as
social skills involved in effective interpersonal
communication.
Affective domain: feeling or emotion (attitudes).
Consistent with increasing calls for greater
appreciation of affective learning outcomes for
sustainable higher education,41 this domain
focuses on important constructs that support
the learning of knowledge and skills, such as
attitudes, values, and motivations.42
We developed KSA-based competencies and
subcompetencies consistent with the schema of
American Journal of Public Health | April 2014, Vol 104, No. 4
Gebbie and Gill,43 afrming the importance of
competency statements possessing an action
verb (observable or measurable performance
of a worker), content (subject matter, type of
performance, specic task), and context (limi-
tations, conditions, or work environment).
RESULTS
The resulting product is PFA Competency
Set 1.0, an 18-cell matrix of consensus-based,
empirically supported KSAs constituting 6 PFA
competency domains:
1. initial contact, rapport building, and stabili-
zation;
2. brief assessment and triage;
3. intervention;
4. triage;
5. referral, liaison, and advocacy; and
6. self-awareness and self-care.
Table 1 provides the behavioral descriptions
of the KSA-based subcompetencies consti-
tuting each competency domain. Important
considerations about each domain that are
not easily conveyed in a summary table are
elaborated here.
Initial Contact, Rapport Building, and
Stabilization
This competency domain encompasses
KSAs useful in establishing a positive interper-
sonal relationship, however transitory, within
which subsequent essential elements of crisis
intervention and PFA may be optimally pro-
vided, including initial efforts to deescalate
problematic emotions and behavior. Important
knowledge elements revolve around under-
standing relational (vs technical) factors shown
to facilitate interpersonal helpingfor example,
the ability to communicate empathy, warmth,
genuineness, and positive regard.44---50 These
nonspecic helper attributes can enhance the
providers technical interventions.
Of special value to effective helping is the
ability to listen attentively and express empathy,
skills that foster a sense of safe environment and
reduce the chances of drawing erroneous con-
clusions about the kind of help the person wants
or needs. Facilitative affective subcompetencies
are evidenced through overt expressions of
warmth and concern for the physical and
 FRAMING HEALTH MATTERS

TABLE 1Psychological First Aid (PFA) Core Competencies and Subcompetencies

Core Competencies and Subcompetencies

Competency Domain Knowledge Skills Attitudes

Initial contact, rapport building, and
stabilization (positions provider for
optimal effectiveness and efficiency
with other PFA competencies)
Brief assessment and triage (informs
acute intervention)
Intervention (assumes prior determination
of actual or probable dysfunction)
Triage (informs postacute referral for
post-PFA interventions)
Referral, liaison, and advocacy (facilitates
access to continued support or care,
as indicated)
Self-awareness and self-care (a prerequisite
for caring for others)
Describes the effectiveness of relational and
technical influences on counseling and
behavior change.
Defines characteristics of functional vs
dysfunctional behavior.
Describes the importance of mitigating acute
distress and fostering adaptive functioning
and coping.
Describes triage criteria using a response-
based triage system (i.e., immediate
or delayed).
Describes mechanisms of liaison and advocacy
and knowledge of referral resources.
Identifies at least 5 possible signs of personal
stress, burnout, and vicarious trauma, and
knows at least 5 self-care principles and
practices such as proper nutrition, exercise,
and sleep.
Applies principles of active and reflective
listening skills, expressing empathy,
and establishing rapport.
Performs screening and assessment to
distinguish between functional vs
dysfunctional behavior.
Applies intervention techniques for
mitigating acute distress and fostering
adaptive functioning and coping.
Demonstrates ability to recognize and
differentiate individuals requiring
immediate care from those who
need no care (or whose care is
considered deferrable).
Demonstrates timeliness and persistence
in referring persons requiring more
intensive care to appropriate postevent
care providers and programs.
Applies appropriate techniques for
maintaining awareness of possible
signs of personal stress, burnout,
and vicarious trauma and for using
self-care principles and practices to
mitigate potential adverse effects.
Expresses a positive manner of relating to
others by being warm and nonjudgmental,
and showing respect for people and their
differences (e.g., ethnic, racial, age-related,
political).
Reports that the screening and assessment
is useful to discern between functional and
dysfunctional behavior.
Expresses confidence in ability to perform
techniques to mitigate acute distress and
foster adaptive functioning and coping.
Reports confidence in triage capabilities in
situations characterized by high stress
and uncertainty.
Expresses confidence in ability to make
referrals, and serves as a liaison and
advocate.
Acts as a composed leader during crises
by monitoring and managing personal stress,
burnout, and vicarious trauma, and by
using self-care principles and practices to
mitigate potential adverse effects.

Note. The competencies were developed under the auspices of the Centers for Disease Control and Prevention and the Association of Schools of Public Health.

emotional comfort of distressed persons, and
by being nonjudgmental and sensitive to issues
of privacy and condentiality.
Brief Assessment and Triage
Brief assessment and triage, which is ideally
unobtrusive and typically brief in most acute
disaster contexts, is a competency domain
encompassing screening and assessment activ-
ities designed to differentiate functionally dis-
crete subsamples of PFA recipients, and to
determine acute (i.e., immediate) intervention
needs; it is comparable to determining the need
to stanch arterial bleeding in physical rst aid.
Assessment entails an initial screening effort
to answer questions with a presumed binary
answer (yes or no); for example, Is there
a problem requiring immediate intervention?;
Is further exploration into a persons capacity
for adaptive mental and behavioral functioning
warranted? If the screen indicates that addi-
tional appraisal is necessary, further assessment
poses dimensional questions; for example,
To what extent do factors exist in which
adaptive functioning is being, or may be,
compromised? Addressed here are character-
istics such as degree of psychophysiological
distress, cognitive and intellectual functioning,
affective and behavioral expression, and in-
terpersonal and material resources.
Differentiating functional and dysfunctional
behavior rests on a general understanding of the
human stress response51,52 and familiarity with
the notion of activities of daily living and instru-
mental activities of daily living53,54constructs
borrowed from psychiatric recovery and re-
habilitation contexts that refer to everyday
maintenance activities associated with personal
hygiene, homemaking, employment, nancial
management, and so on. This orientation is
compatible with a resilience framework rather
than a pathology orientation,55,56 and is con-
sidered more suitable for public health workers
and lay PFA providers who may not possess
a thorough knowledge of psychological
constructs.
Intervention
The knowledge required for appropriate
immediate intervention is based on under-
standing principles of mitigating acute distress
by fostering adaptive coping, both to amelio-
rate acute distress and to forestall the devel-
opment of enduring mental health problems
such as posttraumatic stress disorder and pro-
tracted grief or depression. Core skills sub-
competencies entail the ability to apply

April 2014, Vol 104, No. 4 | American Journal of Public Health McCabe et al. | Peer Reviewed | Framing Health Matters | 623

interventions to modify aspects of the persons
cognitive, behavioral, physiological, or emo-
tional life that may be impairing function. For
example, the PFA provider might seek to re-
duce a persons distress by using simple dis-
traction, guidance, and advice giving, or might
perform more advanced interventions, such as
cognitive reframing and psychophysiological
self-regulation approaches (e.g., diaphragmatic
breathing).
Facilitative attitude and affective subcom-
petencies are revealed in provider statements
that reect an understanding that psychological
distress is normally expected under many
situations and that interventions, though typi-
cally not needed, can be performed with
condence.
Triage
Triage, as used here, denotes a decision-
making process by which persons experiencing
distress, including adversely affected re-
sponders and caregivers, are determined to
need follow-up services or resources not avail-
able in the immediate setting, including clinical
treatment of an intensity available only in
a formal continuum of care. This postacute
intervention triage function is differentiated
here from the preacute intervention assess-
ment and triage activity of Competency Do-
main 2. Triage prociency assumes knowledge
of behavioral or response-based criteria for
identifying impairments to key activities of
daily living and instrumental activities of daily
living, and prioritization decisions based on
such knowledge. The response-based approach
may be distinguished from, but may be
Response-Based Criteria Indicative of Need for a Higher Level of Care Intensity
Criteria
d Sustained neuromuscular immobility, freezing
d Traumatic psychogenic amnesia
d Dissociation, depersonalization, derealization
d Extreme sympathetic nervous system dysfunction (e.g., panic attacks, malignant arrhythmias)
d Dysfunctional parasympathetic nervous system arousal
d Lingering or dysfunctional guilt reactions (survivor guilt, responsibility guilt)
d Giving up (e.g., helplessness, hopelessness)
d Self-destructive ideation (e.g., suicidal or homicidal ideation)
d Any persistent interference with significant activities of daily living, including occupational interference
d Any significant interference with caretaking responsibilities
624 | Framing Health Matters | Peer Reviewed | McCabe et al.
FRAMING HEALTH MATTERS
combined with, an experiential, or event-based,
approach to triage decisions, whereby certain
aspects of the survivors experience are con-
sidered predictors of posttraumatic disorders
(e.g., level of trauma exposure).57
Operational skill in differentiating individ-
uals requiring immediate or higher-level psy-
chological support beyond acute crisis inter-
vention58 depends on recognizing and reacting
to criteria indicative of the need for a higher
level of care intensity (Box 1).
Referral, Liaison, and Advocacy
Referral, liaison, and advocacy competen-
cies are the operations by which effective
connection to needed resources is achieved.
Minimally, liaison entails connecting a person
in crisis with competent resources for contin-
ued postacute care or support, including
return to ones natural familial, social, work-
place, community, or spiritual support system.
Advocacy involves promoting, on behalf of
the person in crisis, needed support and
benets from a third-party resource. Vital to
these functions is the PFA providers knowl-
edge of when, where, and how to effect these
person---resource linkages, as well as timeli-
ness, persistence, and prociency in following
up on persons requiring more intensive as-
sistance from postevent care providers and
programs.
Self-Awareness and Self-Care
To maintain effectiveness, PFA providers
have the responsibility of avoiding problematic
levels of secondary stress (also referred to as
burnout, vicarious trauma, or compassion
American Journal of Public Health | April 2014, Vol 104, No. 4
fatigue) associated with their caregiver roles.59
Self-care should be considered a prerequisite
for caring for others. Key areas of knowledge
for prospective PFA providers are the func-
tional domains in which stress may be
exhibited: (1) vegetative (e.g., problems with
sleep and eating), (2) affective (e.g., anxiety and
depression), (3) cognitive (e.g., inability to
concentrate or focus on tasks), and (4) behav-
ioral (e.g., interpersonal conict, social with-
drawal, and problematic use of alcohol or
drugs).
Logically, important self-care techniques for
mitigating potential adverse effects in these 4
spheres include adhering to healthy nutrition
principles, participating in a regular exercise
regimen, establishing regular sleep and rest
cycles, scheduling vacations and down-time for
oneself, and participating in gratifying activities
such as hobbies or social events with friends
and family members. Core affective or attitu-
dinal subcompetencies will be evident when
PFA responders and organizational leaders
maintain their composure during crises. Crisis
responders tend to appraise their professional
roles and encounters as less stressful if they
possess high levels of perceived self-efcacy in
their roles.60
DISCUSSION
PFA Competency Set 1.0 is the rst national
curriculum for PFA training linked to KSA
domains of a widely accepted pedagogical
model. It represents progress in responding to
the increasing number of students, teachers,
organizations, and regulatory agencies who
expect competency-based curricula,61---65 and to
the specic mandate in the Pandemic and
All-Hazards Preparedness Act of 200633 to
develop a competency-based program to train
public health practitioners to performance
benchmarks that promote public health pre-
paredness and response. By incorporating uni-
versally applicable conceptual elements and
operational experience from eld trials, the
framework is proving feasible and effective for
the training of lay (nonpublic health, nonpro-
fessional) PFA providers. Moreover, the con-
tent is consistent with empirically established
principles of immediate mass trauma interven-
tion: to promote a sense of safety, calming, self-
and collective efcacy, connectedness, and

hope.29,66 Although the approach assumes that
PFA should be available to all persons who
want and need its component services, with the
exception of persons observed to be a danger
to themselves or others, it does not assume that
administrations of PFA should be mandatory
for all who have experienced a disaster or other
public health emergency.
An obstacle to the adoption of any new
competency set (and to the efcient diffusion
of evidence-based innovations in public
health in general) is the near-total absence
of an extant infrastructure, or system, through
which the requisite efforts might be accom-
plished.67 Questions inherent to this challenge
include the following: To whom should the
competencies be disseminated? How should
(training in) the competencies be imple-
mented, and through which organizational
linkages and supports? What steps should
be followed to optimize the tailoring to, and
evaluation with, prospective user groups
and at-risk populations (e.g., children)? What
pedagogical methods and media should be
employed, and how will their respective ef-
fectiveness be documented? Through which
private and public health infrastructures
might translational impact be validated?
Although an in-depth consideration of
these questions is beyond the scope of this
report, PFA Competency Set 1.0 has been
disseminated to public health and lay audi-
ences, and practical issues have begun to be
addressed systematically through a 5-category
logic model68 that would appear to be
a promising framework for guiding future
work:
1. Review and incorporate postdissemination
feedback from members of key stakeholder
groups (input);
2. Implement and evaluate the competency set
with specic user groups (activities);
3. Develop customized tools and resources
for example, slides, handouts, manuals,
guides to support delivery to and renement
with trainee cohorts (outputs);
4. Collect data to conrm increased disaster
literacy and PFA response competencies of
individual trainees (outcomes); and
5. Promote model uptake, diffusion, and
translation to real-world public health
emergencies (impact).
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FRAMING HEALTH MATTERS
Application With Residents of Lay
Communities
Adhering to the steps of the logic model,
PFA Competency Set 1.0 has been dissemi-
nated to, and continues to be implemented
with, lay community trainees. This application
with populations envisioned to be public health
extenders is being administered through part-
nerships composed of academic health centers,
local health departments, and faith-based or-
ganizations. Evidence of the effectiveness of the
current competency set, or its precursors, de-
livered through this systems-based infrastruc-
ture has been collected in multiple geographic
areas of the United States (Illinois, Iowa, and
Maryland), in varied residential locales (urban,
suburban, and rural), and with several ethno-
racial groups (African American, White, and
Hispanic) of different faiths (Christian, Jewish,
and Muslim). Across all trial cohorts, signicant
pre---post changes in measures of KSA-linked
PFA competencies and disaster literacy have
been consistently documented.16,26,69---71
Along with the data supporting the feasibility
and effectiveness of the model, evidence of
the translational impact of the PFA training
framework is also emerging as community
trainees who receive certicates of course
completion are being registered as a new
class of deployable disaster volunteers in se-
lected state Medical Reserve Corps. For exam-
ple, the leadership of the Maryland Medical
Reserve Corps, initially limiting membership
to health care workers with licensure in a
state-recognized profession (e.g., psychologist,
physician, nurse), has been collaborating
with the authors in instituting a protocol
whereby the lay, PFA-trained applicants are
pre-identied, qualied, and approved as
paraprofessional volunteers for future activa-
tion during public health emergencies. This
private---public partnership model is viewed
by state and local government ofcials as
a viable, scalable approach to behavioral
health surge capacity building. Box 2 sum-
marizes the key steps currently being used to
incorporate program trainees into the Medical
Reserve Corps.
Application With the Public Health
Workforce
The intent is to continue to implement
a participatory approach70---73 to engaging
McCabe et al. | Peer Reviewed | Framing Health Matters | 625
diverse constituencies in the process of ad-
vancing the competency set. Although dissem-
ination and evaluation activities are well under
way with community-based cohorts, there is
limited evidence to date of the utility of PFA
Competency Set 1.0 with public health workers.
Accordingly, this report is a distribution and
call for input to the broad public health
community, complementing dissemination
of the set to public health leaders in selected
PERLCs and their networks of practice
partners.
Limitations and Strengths
The limitations of this and all consensus-
derived competency sets, even when supple-
mented by eld validation, are readily ac-
knowledged. They include the risk of excessive
focus on elements, with corresponding inat-
tention to patterns, synthesis, and matters of
the whole.61 Disproportional attention given to
specic competencies also runs the risk of
ignoring the importance of situational problem-
solving, critical thinking, and other emergent
behaviors found to be critical in individual and
community crisis response. As PFA Compe-
tency Set 1.0 is considered a base framework to
be tailored to each setting of application, it is
anticipated that awareness of these limitations
can mitigate their potential for negative in-
uence in future settings where it may be
applied.
Achieving prociency in the competencies
will require training. Although the framework
establishes a sound conceptual platform of
training content, it does not prescribe the pro-
cesses for imparting the content to individual
trainee cohorts. Would-be adopters are there-
fore encouraged to offset this limitation by
aligning module-specic learning objectives
with information gathered from needs assess-
ments and with best teaching practices. Imple-
menters should make full use of traditional
in-person formats (using large classroom, small
group, train-the-trainer, and exercise-based
formats), as well as more contemporary ap-
proaches, including synchronous broadcasting,
online, and video---CD formats. Ideally, delivery
methods will be stratied into culturally ap-
propriate cognitive and behavioral approaches,
with knowledge (and to a lesser extent attitu-
dinal or affective) competencies being amena-
ble to any of these approaches and skills
 FRAMING HEALTH MATTERS

Current Protocol for Registering Psychological First Aid (PFA)-Trained Prospective Responders Into the
Medical Reserve Corps of the State of Maryland

Chronological Sequence of Key Activities

Pre-PFA training
d PFA training organization notifies MPVC coordinator of training date, time, and location;
d MPVC Coordinator, or designee, confirms availability and intention to attend PFA training;
PFA training day
d MPVC representative sets up computer work stations for on-line applications at training site;

d MPVC representative gives a brief (1015 min), lunch-time presentation about MPVC to all participants;
d Following receipt of certificates of course completion, PFA trainees submit on-line MPVC applications; MPVC representative provides technical assistance, as needed;
Post-PFA training day
d MPVC implements other (non-PFA-related) criteria for approving applicants (e.g., criminal background checks, photo-ID badges);
d In the event of a public health emergency, volunteers are called up and deployed (and have the benefits of professional liability and Workers Compensation insurance coverage).

Note. The Medical Reserve Corps of the State of Maryland is known as the Maryland Professional Volunteer Corps (MPVC), Office of Preparedness and Response, Department of
Health and Mental Hygiene.

training more suitably delivered in person,
using interactive teaching methods.74,75 It
should be anticipated that some audiences
will prefer in-person trainings and avoid the
use of online technology. Those for whom
participant reach and program sustainability
objectives are priorities may prefer train-the-
trainer formats.
Conclusions
Notwithstanding these shortcomings, PFA
Competency Set 1.0 would appear to em-
body multiple advances for the eld of PFA
training, and its development is consistent with
competency verbs denoting observable be- edited the entire manuscript and provided original,
substantive contributions to the Methods, Pedagogical
havior, facilitates objective evaluation of
Domains, and Discussion sections.
prociencies. j
Acknowledgments
This work was supported by the Centers for Disease
About the Authors
O. Lee McCabe, George S. Everly Jr, and Jonathan M. Links
Control and Prevention through a Cooperative Agree-
ment with the Association of Schools of Public Health.
are with the Johns Hopkins Bloomberg School of Public
Grants awarded to the authors institutions under the
Health and the Johns Hopkins School of Medicine, Balti-
agreement are as follows: Bloomberg School of Public
more, MD. Lisa M. Brown is with the College of Behavioral
Health, Johns Hopkins University (1U90TP000397);
and Community Sciences, University of South Florida,
College of Behavioral and Community Sciences, Univer-
Tampa. Aaron M. Wendelboe and Vicki L. Tallchief are
sity of South Florida (1U90 TP000414); College of
with the College of Public Health, University of Oklahoma
Public Health, University of Oklahoma Health Sciences
Health Sciences Center, Oklahoma City. Nor Hashidah
Abd Hamid is with the College of Public Health, University
Center (1U90TP000420); College of Public Health,
University of Iowa (1U90TP000407).
of Iowa, Iowa City.
Correspondence can be sent to O. Lee McCabe, PhD,

other competency initiatives to ensure ac-

countability in public health education and
training.61---65,76,77 Among its strengths, this
new competency set (1) is appropriate for many
types of psychological crises; (2) is suitable
for training both professional and lay partici-
pants; (3) is applicable to a broad range of
disaster events (thereby aligning with the na-
tional all-hazards preparedness mandate);
(4) is pedagogically sound, anchored to state-
of-the art educational principles and com-
prehensive learning domains; (5) is nonde-
nominational in ideological orientation,
eschewing parochial theories of psychopathol-
ogy (in favor of more neutral and utilitarian
emphases on functionality and resilience); (6)
builds on, rather than replaces, the contribu-
tions of foregoing PFA developers and in-
vestigators; and (7) by employing the use of
Department of Mental Health, Johns Hopkins Bloomberg
School of Public Health, 624 N Broadway, Ste 390,
Baltimore, MD 21205 (e-mail: lmccabe@jhsph.edu).
Reprints can be ordered at http://www.ajph.org by clicking
the Reprints link.
This article was accepted December 29, 2012.
Contributors
O. L. McCabe had lead responsibility for developing the
overall article, including writing the initial draft of the
18-cell, psychological rst aid competency matrix,
searching and reviewing the literature, writing the
content for the section Initial Contact, Rapport Building,
and Stabilization, and writing portions of the Methods
and Discussion sections. G. S. Everly Jr. led the writing of
the sections Brief Assessment and Triage, Triage, and
Referral, Liaison, and Advocacy. L. M. Brown led
writing of the section Intervention and contributed to
the development of the Methods section. A. M. Wendel-
boe had lead responsibility for searching and reviewing
the literature on behavioral health surge and psycho-
logical rst aid and for writing the introduction of the
article. N. H. Abd Hamid led the writing of the section
Pedagogical Domains. V. L. Tallchief led the writing of
the section Self-Awareness and Self-Care. J. M. Links
Human Participant Protection
No protocol approval was necessary because there were
no human participants involved in the project.
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